轻型非致残性脑卒中静脉溶栓疗效及预后不良的相关因素研究
A Study of Related Factors to Efficacy and Poor Prognosis of Intravenous Thrombolysis in Mild Non-disabling Stroke
胡媛媛 1马芸1
作者信息
- 1. 南京医科大学附属宿迁第一人民医院神经内科,宿迁 223800
- 折叠
摘要
目的 探讨重组组织型纤溶酶原激活剂(阿替普酶)治疗轻型非致残性急性缺血性脑卒中(AIS)的临床疗效,分析90 d预后不良的相关临床和影像学因素.方法 连续纳入2020年5月至2023年5月就诊的350例NIHSS评分0～5分且发病至溶栓时间≤4.5 h的轻型非致残性AIS患者.溶栓前均进行了头颅CT灌注成像(CTP)检查,并接受了阿替普酶静脉溶栓治疗,最终312例符合条件患者入选研究.根据随访获得的90 d改良mRS评分,将312例AIS患者分为:预后良好组(mRS 0～1分)和预后不良组(mRS 2～5分).对两组患者的基线资料、CTP缺血灌注区情况和MRA狭窄/闭塞病变进行统计学分析,采用多因素Logistic回归分析判断预后不良患者的独立预测因素.结果 312例患者中,男219例,平均年龄[(63.4±11.3岁)].93/312例(29.8%)90 d mRS评分提示预后不良;122/312例(39.1%)CTP未见缺血灌注区.多因素分析中,90 d改良mRS评分提示不良预后与糖尿病病史(P=0.039)、入院时NIHSS评分(P=0.001)、CTP无缺血灌注区(P=0.003)具有相关性.CTP无缺血灌注区与早期神经功能恶化(P=0.032)、责任血管中重度狭窄(P=0.019)具有独立相关性.CTP存在缺血灌注区患者心源性栓塞发生率较高(P=0.009).结论 较高的NIHSS评分、糖尿病病史和CTP无缺血灌注区可能有助于预测接受静脉rt-PA治疗的轻度非致残性AIS患者的不良预后.
Abstract
Aim To probe the clinical efficacy of alteplase in the treatment of mild non-disabling acute ischemic stroke(AIS)and investigate the clinical and imaging factors associated with poor 90-day prognosis.Methods Three hundred and fifty patients with mild non-disabling AIS with National Institutes of Health Stroke Scale(NIHSS)score of 0-5 and onset within 4.5 hours were included consecutively,who attended the outpatient emergency treatment of the Suqian First People's Hospital from May 2020 to May 2023.They underwent cranial CT perfusion imaging(CTP)examination before thrombolysis and received recombinant tissue plasminogen activator(rt-PA)intravenous thrombolytic therapy.Finally,312 eligible patients were analyzed and studied.The patients were divided into a good prognosis group(mRS score of 0-1)and a poor prognosis group(mRS score of 2-5)based on the mRS scores obtained at 90 days of follow-up.Baseline data,ischemia perfusion status on CTP,and stenotic/occlusive diseases on MRA were statistically processed in both the groups,and independent predictors of poor prognosis patients were determined via multivariate Logistic regression analysis.Results Among 312 patients[219 male patients,mean age(63.4±11.3 years old)],93(29.8%)patients had a poor prognosis at 90 days,and 122(39.1%)patients were found with ischemia-free perfusion area on CTP.Based on the results of multivariate analysis,poor prognosis at 90 days were associated with diabetes(OR=3.41,95%CI:1.06～10.9,P=0.039),NIHSS score on admission(OR=2.11,95%CI:1.35～3.30,P=0.001)and ischemia-free perfusion area on CTP(OR=4.19,95%CI:1.63～10.80,P=0.003).Ischemia-free perfusion area on CTP was independently associated with early neurologic deterioration(P=0.032)and moderate to severe stenosis of responsible vessel(P=0.019).The patients with ischemia perfusion area on CTP had higher incidence of cardiac embolism(P=0.009).Conclusion Higher NIHSS scores,diabetes,and ischemia-free perfusion area on CTP may help predict poor prognosis in patients with mild non-disabling AIS treated with intravenous rt-PA therapy.
关键词
轻型非致残性脑卒中/静脉溶栓/CT灌注成像/预后/影响因素/重组组织型纤溶酶原激活剂Key words
mild non-disabling stroke/intravenous thrombolysis/CT perfusion imaging/prognosis/influence factor/recombinant tissue plasminogen activator引用本文复制引用
出版年
2024
NETL
NSTL
万方数据